COVID-19, heart disease and cancer: What is the connection?

In the first month of 2021, COVID-19 was the leading cause of death in the United States, surpassing heart disease and cancer. Except for the 1918 flu pandemic and the emergence of HIV/AIDS in the 1980s, infectious disease mortality declined throughout the 20^th century while chronic conditions have dominated mortality charts. This allowed the health care system to focus on non-communicable and chronic conditions, such as heart disease, diabetes and cancer. However, the arrival and spread of a novel virus in early 2020 changed everything.

As an infectious disease, COVID-19 has shifted attention from chronic disease management to a focus on preventing communicable disease through social distancing and vaccine administration. In the meantime, chronic conditions, and the reasons they have dominated our health care landscape, have not disappeared. The challenge we now face is how to simultaneously confront a pandemic while continuing to address chronic conditions.

The environmental, social and behavioral components of chronic disease are well-established. Where we live and work, how we socialize, and what we choose to eat, drink and do with our time all have an impact on our health. Heart disease, diabetes and many types of cancer do not just happen, but develop over time based on a multitude of clinical and social risk factors.

Infectious disease has an environmental, social and behavioral component, as well.  Viruses and bacteria depend on close human contact to move from one host to another. They also rely on naïve immune systems that can facilitate their propagation. Social distancing, hand washing, masks and vaccines are the best approaches to preventing COVID-19 infection. This requires individual behavior change supported by policies that will promote these changes.

Just as chronic conditions do not arise in a vacuum, neither do the complications related to COVID-19. Older individuals and those with a single chronic condition are more susceptible to developing additional comorbid conditions, including infectious diseases. Health inequities existed prior to COVID-19, but the pandemic has served to expose the magnitude of these inequities.

The approaches that we are taking to address chronic disease must continue as we battle and adapt to the presence of COVID-19. These include the following:

1. Focus on high-risk populations – A disease-specific approach is not enough. Identifying groups at highest risk of morbidity and mortality requires a clinically-based classification and prioritization approach.
2. Promote health equity by addressing social determinants of health – The same issues that have prevented marginalized groups from accessing and receiving high quality and consistent health care are readily apparent in our COVID-19 vaccination efforts.
3. Focus on primary care – The whole-person approach to primary care is essential to the coordination of care, chronic condition management and disease prevention through immunizations and behavior changes that promote healthy behaviors.

Ultimately, the health care crisis that we are now confronting with COVID-19 will diminish. However, the impact will remain, as well as the threat of other novel diseases. That is why it is crucial to continue to build on the foundation of health equity, primary care and addressing the needs of high-risk populations.

Steve Delaronde is manager of products for Population and Payment Solutions at 3M Health Information Systems.

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